Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Tuesday, April 05, 2011

Lessons

It was one of those lectures you never forget.

Years ago, in my first year of medical school, we took our first of many amazing classes: human anatomy. There you were, day 1, all bright-eyed and bushy-tailed, walking to the basement of the hospital with your assigned fellow-students after a rousing introductory lecture into the anatomy lab.

There, in a huge well-lit room, stood a sea of steel tables covered in thick plastic bags with their most unusual contents: human cadavers.

Your first job?

To remove the bag as a team.

No one can forget that day, or that semester for that matter, as a medical student. The smell of formaldehyde that pierces your nostrils and permeates every pore of your hands while seemingly flavoring your lunchtime meals. The smell was your identifier as you stood in the lunch line: you were a first-year.

It would be easy to write about those days in the lab, but this is a story outside the lab that stuck with me through all of these years in the every-Friday lecture called “Clinical Correlations.” In that lecture we would apply the anatomy we had learned from our careful dissections earlier in the week to other clinical scenarios. The class was conducted by a brilliant radiologist. He shared his vast library of carefully-categorized radiographs with us in class and pointed to a spot on the radiographs while asking: “What’s this?” Or as we learned more disease processes that affected anatomy: “What disease might cause this?”

Very cool.

One Friday late in the year after we had completed the laborious task of dissecting the entire abdominal contents, he brought in a series of “unknown” radiographs. He would have us compete to see who could answer correctly first: winner got a trinket; losers (incorrect answers) got public humiliation and laughs from their peers. It was always a very lively class.

Little did we know what he had in store for us.

Up went the first radiograph, a pause, then: “The kid swallowed a penny!” someone would shout. “No, a quarter,” he would answer, “… but close enough.”

Then another. People stared for a while, couldn’t recognize what it was but we all knew it was something mechanical, there, in the projection of the ascending colon. Um, could it be? Yes, another foreign body that had migrated there with the switch turned on. We call cringed, amazed that he had seen such a thing. (We were young).

Then finally, as if we had not had enough, a final flat plate of the abdomen. I think I saw it first, and started laughing. He looked at me with eyes that could have pierced the thick hide of a water buffalo. He didn’t crack a smile at all. Suddenly, another female classmate blurted out, “Oh my goodness, is that a lightbulb?”

He replied to our amusement, “Yes it is: a 60-watt bulb, wide end first, in a 40-watt rectum.” By now the entire class was howling while simultaneously turning to each other and cringing. But he looked serious.

“I’d like to say something to you as future physicians,” he said above the din of laughter. Things quieted a bit as he spoke. “You will see things in your careers that are far stranger than this,” he continued, “and you must forever remember that you are dealing with a real person in real need.” Silence. “This was a situation that required the utmost discretion to manage: can you imagine what would happen to that patient if the bulb broke?” We considered the horrible consequences. “How would you handle this?”

Suddenly, the entire class felt impotent, struggling to imagine themselves in such a scenario. We quickly realized the joke was on us. We were clueless as our minds whirled to find a solution. No one could.

In the end he described the general anesthesia, the delivery forceps, and the team approach required to manage such a challenging situation and closed with these words:

“Guys, no matter how weird, how repulsive, how funny, or how crazy a situation might seem, when you see that person you MUST speak with them as though it’s the fifth case like that you’ve seen that day and respect the person’s dignity no matter what. Don’t ever forget that.”

I've lived in several cities with a large gay population. I once saw a print ad for an internist with a humorous picture of himself snapping a latex glove on his hand, with the caption 'No judgement, no guilt.' This was good, in that some patients who are very promiscious are sometimes judged harshly, when they need healthcare like everyone else.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.